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Intravascular catheters are used for a wide range of adjunctive therapies in pediatric patients, such as administering total parenteral nutrition and chemotherapy and facilitating blood drawing. For the purposes of discussing complication risks and preventive strategies, these catheters can be subdivided into short-term, intermediate-term, and long-term devices. Approaches to catheter device placement and care that prevent infection are discussed in Chapters 34 and 107.

The pathogenesis of bloodstream infections for both short-, intermediate-, and long-term devices includes migration of potential pathogens from the skin at the exit site along the external surface of the catheter to the catheter tip, intraluminal migration of organisms from the catheter hub, contaminated infusates, and rarely, seeding of the catheter hematogenously from a distant focus.1 The true incidence of bowel translocation of microorganisms with subsequent seeding of the catheter is unknown, but this is proposed as a potential mechanism of catheter-related bloodstream infections (CR-BSI) in patients with dysfunctional bowel. Short-term and intermediate-term, noncuffed, nontunneled catheters are more prone to migration of organisms along the external surface of the catheter, and as a result they are infected by a greater proportion of skin flora including coagulase negative staphylococci and Staphylococcus aureus.2-5 Long-term, cuffed, tunneled catheters are less likely to be infected by organisms along the external catheter surface because the cuff acts as a fibrotic dam to migration. The definitions of different types of catheter-related infections are presented in Table 239-1.

Table 239-1. Definitions of Catheter-Related Infections

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